If you have any question for our doctors, please send us an e-mail. We will do our best to give you an expert's answer as soon as possible. Some of our patients’ most frequently asked questions regarding cardiovascular diseases are listed below:

Is there a difference between arteriosclerosis and atherosclerosis?

Yes, there is a difference. These are two different diseases: 

Arteriosclerosis (generally) encompasses a group of diseases with one common characteristic: The loss of elastic fibres in the wall of the blood vessels, and their compensation with connective tissue fibres.

Because of this arteries become stiff and non-elastic.  Basically, arteriosclerosis is one of multiple manifestations of the body growing old.

• Atherosclerosis is one form of arteriosclerosis. This process is characterised by the forming of limited plaques (atheroms) in the blood vessels wall.  These formations consist of fat (lipids), connective tissue and calcium. Growth of these plaques is fast and progressive, and they obstruct the blood vessels lumen in limited length and in that way cause deregulation of blood flow and nutrition of organs and tissue.  Results depend on which arteries are affected.

• Atherosclerosis of coronary arteries is cause of coronary disease

• Atherosclerosis of brain arteries cause cerebrovascular disease with brain attack (stroke)  and others complications

• Atherosclerosis of arteries in legs cause ischemic disease of lower limbs that can result in gangrene and loss of limbs

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What is coronary atherosclerosis?

Coronary atherosclerosis is a process of plaque forming, atherom, in coronary arteries. They start to form after twenty years of age and within the next decade almost nobody is spared of stiff plaques in coronary arteries. The disorder is caused by insufficient blood flow to heart muscle and starts when lumen of one of three big coronary arteries is obstructed more that 50%. Then symptoms, well known as coronary disease, start to show.

What is coronary atherosclerosis?

Coronary disease (coronary heart disease, ischemic heart disease) is a group of symptoms and disorders caused by coronary atherosclerosis, and disorders relating to the transport of oxygen and other substances in the blood. It’s not a singular disorder. It can be found in five forms that can transform one to another.

• Angina pectoris, chronic coronary insufficiency or stabile form of angina pectoris is a state caused by atherosclerosis of coronary arteries and insufficient oxygen supply to the heart muscle, in cases of increase need for it. The main sign of disease is chest pain during the physical extortion, in stress, after large meal and after prompt temperature changes. Angina pectoris is not a stable disease, it progresses during the time and develops into much serious condition.   

• Unstable angina pectoris is more progressed condition with faster and more progressive atherosclerosis in one of bigger coronary arteries. There is also chest pain, but it is stronger and it can show in passive state, with out extern factor provocation. If disease development is not stopped, 40% of patients will have infarct of heart muscle in less that a three months, and 30% more in the next six months.

• Infarct myocardium is a condition of partial heart muscle necrosis (tissue dying). It is caused by complete blood flow in one of coronary arteries and stop of oxygen transport to myocardium. Most commonly it starts when thrombi (blood clot) is formed in blood vessels in place where plaque is already exists in the wall, and this lead to complete obstruction.

Is there a certain warning sign that heart attack is about to happen?

Only in patients with previous angina pectoris. In this group of patients, heart attacks are becoming more frequent and can be stopped with medications. But, it goes only for one third of infarct victims. In most cases infarct is not announced by chest pain or choking/hard breathing. It comes slowly and occurs unexpectedly in the patients’ life "like thunder in clear sky”.

Does one know when a heart attack occurs?

It’s not that simple. Typical pain doesn’t occur in the left side of the chest, but patient feels tight feeling, burnings and pressure. Sometimes this feeling doesn’t go down the left and right arm or the patient just sweats profusely and can end up having pain in the back or even in the abdomen.

If the patient feels heart pain more than for half of an hour, with out any hesitation should call ER! Not a second should be lost, because in that case the only medication is- away to hospital. 

Can one survive a heart attack without feeling it? 

It is possible. That heart attack is called silent and usually is small and of weakest nature.

Are there more and less dangerous types of heart attack?

Yes. It depends on how much time the heart muscle tissue was left without oxygen and how much of it died. Front wall heart attacks are much more dangerous than rear wall and young people cope less than the elderly.

How quickly should assistance be given in a case of heart attack?

Nowadays up to six hours after the obstruction of blood vessels occurred, using medication, the blood clot can be dissolved.  This intervention is 100% successful. If this treatment is applied later it will be less successful. 

Is heart attack hereditary? 

Heart attacks in themselves are not hereditary, but being genetically prone to them is. For example, if parents and grandparents have had or have died from heart and blood vessels disease, the children should lead a healthy way of life.

Can cholesterol obstruct blood vessels that feed the heart?

No. Modern medicine has found a lot of causes of blood vessel obstruction. Still, it is not believed that high blood cholesterol levels can cause it. The cause of obstruction is an increasing number of cells in blood vessel wall and its inner layer. These cells are projected into the arterial interior and can multiply. Then its thin inner layer can easily burst causing a mini bleeding that the body tries to heal.  The blood vessel then shrinks to stop the formation of a small wound.  But the blood vessel is further obstructed that way and can be completely blocked by thrombocytes. Later on cholesterol particles can accumulate on the surface of these narrowings. The first phase involves the growth of cells rather than cholesterol.

Can anything be done to stop the growth of these cells?

Unfortunately, no. To this day this is still understood as a matter of fate. The solution could be traced to the field of gene therapy, but this is still only a possibility in the future.

What are the signs and symptoms of acute heart attack?           

The decrease of blood starts to manifest strongly in the moment when the heart as a muscle pump is under greater demand (increased heart rate, higher blood pressure, extortion, increased body temperature) when heart muscle have higher demand for oxygen. This oxygen insufficiency in certain number of patients is manifested as a pain-angina pain. This pain is the heart muscle alarm saying that it needs oxygen, that’s why angina pain is called “heart muscle scream for oxygen”. Unfortunately, numerous patients don’t have anginas’ pain, in this cases it is a silent ischemia.  

Sudden heart dead is the biggest problem is modern cardiology, because patients get heart attack suddenly, with out any warning sings. This group of patients, in case of heart attack, can be helped only if someone is near by to start prompt heart massage and “mouth to mouth” respiration at the place of the accident because brain cells can’t sustain more than 3-5 minutes without oxygen and in this short period it is unlikely that ER can come.

It’s important to recognise acute heart attack, call ER and in the meantime start resuscitate till paramedics arrive.

These are the reason why we give you symptoms and signs of acute heart attack:

• Feeling of strong tightening or pressure on chest
• Sudden loss of air
• Unbearable chest pain that last for some time
• Pain that started in neck and spreads to jaw and left hand
• Any chest pain that last more that 20 minutes
• Pale, cold, sticky-wet skin
• Nausea and vomiting, from mild to strong
• Vertigo, instability and impossibility to get up
• Irregular heart activity 
• Loss of heart activity-no pulls

A person who identifies any of the above symptoms should be transferred to medical facility, preferable the one with intensive care unite, and even more coronary intensive care unites.